二维超声斑点追踪成像技术评价DHF患者左室收缩功能的临床研究
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摘要
舒张性心力衰竭(diastolic heart failure, DHF)是一组具有心力衰竭症状和体征而左室射血分数正常,以舒张功能异常为特征的临床综合征。流行病学调查数据显示DHF具有较高的发病率和病死率。发病率占所有心力衰竭病例一半以上,病死率与收缩性心力衰竭(systolic heart failure, SHF)相似,但预后明显优于SHF患者。静息状态下,DHF患者左室每搏输出量及射血分数正常,但其左室形态结构及心肌收缩功能正常与否仍存在争议,维持射血分数正常的机制尚不清楚。心肌扭转和应变在心脏功能中起至关重要的作用,是反映左室功能的敏感指标。新近发展的二维斑点追踪(Two-dimensional speckle tracking imaging, 2D-STI)技术通过实时跟踪同一位置心肌在不同帧频间的运动轨迹,可准确、无创地测量左室旋转角度,径向、纵向、环向应变及应变率等参数,能对左室心肌形变及扭转运动进行定性和定量分析,为评价心脏的局部与整体运动力学提供全新的定量方法。本研究旨在运用2D-STI技术评价DHF患者左室内、外膜层心肌旋转运动及径向应变率变化特征,以期为早期准确评价DHF患者心功能提供一种新方法。
第一部分二维斑点追踪成像技术评价舒张性心力衰竭患者左室局部收缩功能
应用2D-STI技术评价DHF患者左室心肌局部收缩功能。入选DHF患者32例,SHF患者20例。结果显示:①正常受检者左室各节段径向应变率曲线呈收缩期正向波和舒张早期、晚期负向波的三主波形态;同一水平不同室壁节段间径向应变率峰值无明显差异。②DHF患者及SHF患者室壁各节段径向应变率曲线形态与正常对照组相似。DHF患者左室同一水平不同节段间SRs差异无统计学意义(P>0.05)。③DHF组所有节段SRs均较正常对照组相应室壁节段SRs低,部分节段减低明显,差异有统计学意义(P<0.05)。SHF患者所有节段SRs显著低于正常受检者及DHF患者(P<0.01)。
第二部分二维超声斑点追踪技术评价舒张性心力衰竭患者左室内、外膜层心肌功能
应用2D-STI技术观测DHF患者左室内、外膜层心肌旋转运动规律及角度峰值,评价DHF患者内、外膜层心肌收缩功能。结果显示:①所有受检者左室同一水平内、外膜层心肌旋转运动方向相同。心尖水平呈逆时针方向旋转,基底水平呈顺时针方向旋转。②心尖水平及基底水平内膜层心肌旋转角度均大于外膜层心肌旋转角度。③与正常对照组相比,DHF及SHF患者心尖水平内膜层心肌旋转角度减低(DHF:5.63±2.20°,SHF:3.01±1.34°,正常:6.69±2.97°,P<0.001);DHF患者心尖水平外膜层心肌旋转角度较正常对照组外膜层心肌旋转角度值减低,但差异无统计学意义。SHF组较正常组及DHF组明显减低。④DHF组基底水平内、外膜层心肌旋转角度与正常对照组相应心肌层旋转角度比较未见明显异常,差异无统计学意义;SHF患者基底水平内、外膜层心肌旋转角度较正常组及DHF组患者显著减低。
结论:
①DHF患者左室各节段径向应变率曲线形态与正常对照组相似,同一水平不同节段间SRs无明差异。
②左室同一水平内、外膜层心肌旋转运动方向相同;心尖水平及基底水平内膜层心肌旋转运动均大于外膜层心肌旋转运动;心尖水平内外膜层心肌旋转运动大于基底水平心肌旋转运动。
③DHF组节段性室壁SRs及心尖水平内膜层心肌旋转运动减低,射血分数正常的DHF患者局部心肌收缩功能受损。
BACKGROUND Diastolic heart failure(DHF) is a clinical syndrome characterized by the symptoms and signs of heart failure, a preserved ejection fraction (EF), and abnormal diastolic function. Epidemiology investigation shows that about 38%-50% of patients with congestive heart failure are DHF. The mortality and morbidity of DHF is very high. It can be similar to those with systolic heart failure, but the prognosis of DHF is more favorable than systolic heart failure (SHF). Although it is still controversial whether left ventricular (LV) systolic properties are reduced or not, these patients maintain a normal stroke volume and EF at rest. The underlying mechanisms accounting for a normal EF in this group have not been well delineated. Myocardial deformation and LV twist play an important role in cardiac contraction and relaxation. The newly developed two dimensional speckle tracking imaging (2D-STI) technique has presented us with the possibility of enhancing the accuracy of displacement estimation, which was successfully applied to the measurement of myocardial deformation and rotation. Specifically, myocardial deformation in the longitudinal, radial, and circumferential directions can be quantified, and LV twist can be measured. Therefore, we undertook this study to observe the left ventricular segmental peak systolic radial strain rate(SRr)and the characteristics of endocardial and epidcardial rotation by two-dimensional speckle tracking imaging, and to examine myocardial systolic performance in diastolic heart failure patients with a normal left ventricular ejection fraction, and elucidate the contributing mechanisms for a normal EF in patients with DHF.
Part 1 Evaluation of left ventricular regional systolic function in DHF patients by two-dimensional speckle tracking imaging
The purpose of this part is to observe the peak value of systolic radial strain (SRr)rate about segmental left ventricular by two-dimensional speckle tracking imaging(2D-STI), and to evaluate the systolic performance in diastolic heart failure patients(DHF)with normal left ventricular ejection fraction. 32 DHF patients, 20 SHF patients and 32 normal subjects were enrolled in this study. Results:①In all the subjects, the curve character of SRr was similar.②There was no significant difference in SRr between different segments at the same level in both DHF patients and healthy subjects.③All segments SRr were lower in both heart failure groups than in controls, but several segments were depressed to a larger extent in DHF patients, and all segments in SHF patients were reduced significantly than in those with DHF.
Part 2 Evaluation the difference of rotation between endocardium and epidcardium in DHF patients by two-dimensional speckle tracking imaging
The objective of this part is to assess the characteristics of endocardial and epidcardial rotation and evaluate the different rotation in DHF patients. Results:①In all the subjects, the rotation of the endocardium was obviously greater than that of epicardium.②As seen from the apex, LV endocardium and epicardium performed a wringing motion with a clockwise rotation at the base and countclockwise rotation at the apex.③In the apical plane, endocardial rotation was significantly lower in both heart failure groups than that in controls, and was depressed to a larger extent in SHF patients than in those with DHF (control: 6.69±2.97°, DHF: 5.63±2.20°, SHF: 3.01±1.34°, P<0.001). Epicardial rotation has no significant difference between the DHF group and the control group, though it was significantly lower in patients with SHF.④At the base, the rotation of endocardium and epicardium were not different between DHF and control groups,but it was significantly reduced in patients with systolic heart failure.
Conclusions
①In all the subjects, the curve character of SRr was similar. There was no significant difference in SRr among different segments at the same level in both DHF patients and healthy subjects.
②In all the subjects, the rotation of the endocardium was obviously greater than that of epicardium. LV endocardium and epicardium performed a wringing motion with a clockwise rotation at the base and countclockwise rotation at the apex.
③SRr of all segments were lower in both heart failure groups than in controls, but several segments were depressed to a larger extent in DHF patients. In the apical plane, endocardial rotation was significantly lower in DHF patients. The rotation of endocardium and epicardium in the basal and the epicardial rotation were not different between DHF and control groups. Although LV ejection fraction in DHF patients was normal, the systolic function is impaired in DHF patients.
第一部分二维斑点追踪成像技术评价舒张性心力衰竭患者左室局部收缩功能
应用2D-STI技术评价DHF患者左室心肌局部收缩功能。入选DHF患者32例,SHF患者20例。结果显示:①正常受检者左室各节段径向应变率曲线呈收缩期正向波和舒张早期、晚期负向波的三主波形态;同一水平不同室壁节段间径向应变率峰值无明显差异。②DHF患者及SHF患者室壁各节段径向应变率曲线形态与正常对照组相似。DHF患者左室同一水平不同节段间SRs差异无统计学意义(P>0.05)。③DHF组所有节段SRs均较正常对照组相应室壁节段SRs低,部分节段减低明显,差异有统计学意义(P<0.05)。SHF患者所有节段SRs显著低于正常受检者及DHF患者(P<0.01)。
第二部分二维超声斑点追踪技术评价舒张性心力衰竭患者左室内、外膜层心肌功能
应用2D-STI技术观测DHF患者左室内、外膜层心肌旋转运动规律及角度峰值,评价DHF患者内、外膜层心肌收缩功能。结果显示:①所有受检者左室同一水平内、外膜层心肌旋转运动方向相同。心尖水平呈逆时针方向旋转,基底水平呈顺时针方向旋转。②心尖水平及基底水平内膜层心肌旋转角度均大于外膜层心肌旋转角度。③与正常对照组相比,DHF及SHF患者心尖水平内膜层心肌旋转角度减低(DHF:5.63±2.20°,SHF:3.01±1.34°,正常:6.69±2.97°,P<0.001);DHF患者心尖水平外膜层心肌旋转角度较正常对照组外膜层心肌旋转角度值减低,但差异无统计学意义。SHF组较正常组及DHF组明显减低。④DHF组基底水平内、外膜层心肌旋转角度与正常对照组相应心肌层旋转角度比较未见明显异常,差异无统计学意义;SHF患者基底水平内、外膜层心肌旋转角度较正常组及DHF组患者显著减低。
结论:
①DHF患者左室各节段径向应变率曲线形态与正常对照组相似,同一水平不同节段间SRs无明差异。
②左室同一水平内、外膜层心肌旋转运动方向相同;心尖水平及基底水平内膜层心肌旋转运动均大于外膜层心肌旋转运动;心尖水平内外膜层心肌旋转运动大于基底水平心肌旋转运动。
③DHF组节段性室壁SRs及心尖水平内膜层心肌旋转运动减低,射血分数正常的DHF患者局部心肌收缩功能受损。
BACKGROUND Diastolic heart failure(DHF) is a clinical syndrome characterized by the symptoms and signs of heart failure, a preserved ejection fraction (EF), and abnormal diastolic function. Epidemiology investigation shows that about 38%-50% of patients with congestive heart failure are DHF. The mortality and morbidity of DHF is very high. It can be similar to those with systolic heart failure, but the prognosis of DHF is more favorable than systolic heart failure (SHF). Although it is still controversial whether left ventricular (LV) systolic properties are reduced or not, these patients maintain a normal stroke volume and EF at rest. The underlying mechanisms accounting for a normal EF in this group have not been well delineated. Myocardial deformation and LV twist play an important role in cardiac contraction and relaxation. The newly developed two dimensional speckle tracking imaging (2D-STI) technique has presented us with the possibility of enhancing the accuracy of displacement estimation, which was successfully applied to the measurement of myocardial deformation and rotation. Specifically, myocardial deformation in the longitudinal, radial, and circumferential directions can be quantified, and LV twist can be measured. Therefore, we undertook this study to observe the left ventricular segmental peak systolic radial strain rate(SRr)and the characteristics of endocardial and epidcardial rotation by two-dimensional speckle tracking imaging, and to examine myocardial systolic performance in diastolic heart failure patients with a normal left ventricular ejection fraction, and elucidate the contributing mechanisms for a normal EF in patients with DHF.
Part 1 Evaluation of left ventricular regional systolic function in DHF patients by two-dimensional speckle tracking imaging
The purpose of this part is to observe the peak value of systolic radial strain (SRr)rate about segmental left ventricular by two-dimensional speckle tracking imaging(2D-STI), and to evaluate the systolic performance in diastolic heart failure patients(DHF)with normal left ventricular ejection fraction. 32 DHF patients, 20 SHF patients and 32 normal subjects were enrolled in this study. Results:①In all the subjects, the curve character of SRr was similar.②There was no significant difference in SRr between different segments at the same level in both DHF patients and healthy subjects.③All segments SRr were lower in both heart failure groups than in controls, but several segments were depressed to a larger extent in DHF patients, and all segments in SHF patients were reduced significantly than in those with DHF.
Part 2 Evaluation the difference of rotation between endocardium and epidcardium in DHF patients by two-dimensional speckle tracking imaging
The objective of this part is to assess the characteristics of endocardial and epidcardial rotation and evaluate the different rotation in DHF patients. Results:①In all the subjects, the rotation of the endocardium was obviously greater than that of epicardium.②As seen from the apex, LV endocardium and epicardium performed a wringing motion with a clockwise rotation at the base and countclockwise rotation at the apex.③In the apical plane, endocardial rotation was significantly lower in both heart failure groups than that in controls, and was depressed to a larger extent in SHF patients than in those with DHF (control: 6.69±2.97°, DHF: 5.63±2.20°, SHF: 3.01±1.34°, P<0.001). Epicardial rotation has no significant difference between the DHF group and the control group, though it was significantly lower in patients with SHF.④At the base, the rotation of endocardium and epicardium were not different between DHF and control groups,but it was significantly reduced in patients with systolic heart failure.
Conclusions
①In all the subjects, the curve character of SRr was similar. There was no significant difference in SRr among different segments at the same level in both DHF patients and healthy subjects.
②In all the subjects, the rotation of the endocardium was obviously greater than that of epicardium. LV endocardium and epicardium performed a wringing motion with a clockwise rotation at the base and countclockwise rotation at the apex.
③SRr of all segments were lower in both heart failure groups than in controls, but several segments were depressed to a larger extent in DHF patients. In the apical plane, endocardial rotation was significantly lower in DHF patients. The rotation of endocardium and epicardium in the basal and the epicardial rotation were not different between DHF and control groups. Although LV ejection fraction in DHF patients was normal, the systolic function is impaired in DHF patients.
引文
1. Zile MP, Brutaert DL. New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation, 2002, 105: 1387-1393.
2. Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med, 2006, 355: 251–259.
3. Abhayaratna WP, Marwick TH, Smith WT, et al. Characteristics of left ventricular diastolic dysfunction in the community: an echocardiographic survey. Heart, 2006, 92:1259–1264.
4.中华医学会心血管病分会,中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南.中华心血管病杂志. 2007, 35:1089-1090.
5. Zile MR, Baicu CF, Gaasch WH. Diastolic heart failure-abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med, 2004, 350: 1953–1959.
6. Edvardsen T, Gerber BL, Garot J, et al. Quantitative assessment of intrinsic regional myocardial deformation by doppler strain rate echocardiography in humans: validation against three-dimensional tagged magnetic resonance imaging. Circulation, 2002, 106: 50-56.
7. Fang ZY, Leano R, Marwick TH. Relationship between longitudinal and radial contractility in subclinical diabetic heart disease. Clin Sci (Lond), 2004, 106: 53-60.
8. Hansen A, Johansson BL, Wahren J, et al. C-peptide exerts beneficial effects on myocardialblood ?ow and function in patients with type 1 diabetes. Diabetes, 2002, 51:3077-3082.
9. Schneider C, Jaquet K, Malisius R, et al. Attenuation of cardiac remodelling by endocardial injection of erythropoietin: ultrasonic strain-rate imaging in a model of hibernating myocardium. Eur Heart J, 2007, 28: 499-509.
10. Wong CY, O’Moore-Sullivan T, Leano R, et al. Alterations of left ventricular myocardial characteristics associated with obesity. Circulation, 2004, 10:3081-3087.
11. Becker M, Hoffmann R, Kühl HP, et al. Analysis of myocardial deformation based on ultrasonic pixel tracking to determine transmurality in chronic myocardial infarction.Eur Heart J, 2006, 27:2560-2566.
1. Zile MP, Brutaert DL. New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation, 2002, 105: 1387-1393.
2. Shammas RL, Khan NUA, Nekkanti R. Diastolic heart failure and left ventricular diastolic dysfunction: What we know, and what we don't know! International Journal of Cardiology, 2007, 115 :284-292.
3.中华医学会心血管病分会,中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南.中华心血管病杂志. 2007, 35:1089-1090.
4. Dhar S, Koul D, Gilbert E, et al. Current concepts in diastolic heart failure. J Am Osteopath Assoc, 2008, 108: 203-209.
5. Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med, 2006, 355: 251-259.
6. Wang JW, Dirar SK, Yue Y, et al. Preserved left ventricular twist and circumferential deformation, but depressed longitudinal and radial deformation in patients with diastolic heart failure. Euro H J, 2008, 29:1283-1289.
7. Buchalter MB, Rademakers FE, Weiss JL, et al. Rotational deformation of the canine left ventricle measured by magnetic resonance tagging: effects of catecholamines, ischaemia, and pacing. Circulation, 1994, 28:629-635.
8. Torrent-Guasp F, Buckberg GD, Clemente C, et al. The structure and function of the helical heart and its buttress wrapping.I.The normal macroscopic structure of the heart. Semin Thorac Cardiovasc Surg, 2001, 13: 301-319.
9. Goffinet C, Chenot F, Robert A, et al. Assessment of subendocardial vs. subepicardial left ventricular rotation and twist using two-dimensional speckle tracking echocardiography: comparison with tagged cardiac magnetic resonance, European Heart Journal , 2009, 30: 608-617.
10. Rademakers FE, Buchalter MB, Rogers WJ, et al. Dissociation between left ventricular untwisting and filling. Accentuation by catecholamines. Circulation, 1992, 85:1572-1581.
11. Akagawa E, Murata K, Tanaka N, et a1. Left ventricular apical rotation is impaired inpatients with dilated cardiomyopathy:quantitative analysis by two-dimensional tissue tracking system. J Am Coll Cardiol, 2006, 47:97A.
12. Martinez DA, Guhl DJ, StanleyWC, Vailas AC. Extracellular matrix maturation in the left ventricle of normal and diabetic swine. Diabetes Res Clin Pract 2003, 59:1-9.
13.李朝军,刘望彭,谢明星等,超声二维斑点追踪显像Logistic回归联合评价慢性心功能不全患者心肌扭转的改变.中国超声医学杂志, 2008, 24, 506-510.
1. Zile MP, Brutaert DL. New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation, 2002, 105: 1387-1393.
2. Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med, 2006, 355: 251–259.
3. Abhayaratna WP, Marwick TH, Smith WT, et al. Characteristics of left ventricular diastolic dysfunction in the community: an echocardiographic survey. Heart, 2006, 92:1259–1264.
4.中华医学会心血管病分会,中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南.中华心血管病杂志, 2007, 35:1089-1090.
5. Shammas RL, Khan NUA, Nekkanti R, et al. Diastolic heart failure and left ventricular diastolic dysfunction: What we know, and what we don't know! International Journal of Cardiology, 2007, 115:284-292.
6. Paulus WJ, Tschope C, Sanderson JE, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J, 2007, 28:2539-2550.
7. Maurer MS, Burkhoff D, Fried LP. DW, et al. Ventricular structure and function in hypertensive participants with heart failure and a normal ejection fraction: the Cardiovascular Health Study. J Am Coll Cardiol, 2007, 49:972-981.
8. Wang JW, Dirar SK, Yue Y, et al. Preserved left ventricular twist and circumferential deformation, but depressed longitudinal and radial deformation in patients with diastolic heart failure. Euro H J, 2008, 29:1283-1289.
9. Martinez DA, Guhl DJ, Stanley WC, et al. Extracellular matrix maturation in the left ventricle of normal and diabetic swine. Diabetes Res Clin Pract, 2003, 59:1-9.
10. Shan K, Bick RJ, Poindexter BJ, et al. Relation of tissue Doppler derived myocardial velocities to myocardial structure and beta-adrenergic receptor density in humans. J Am Coll Cardiol, 2000, 36:891-896.
11. Park TH, Nagueh SF, Khoury DS, et al. Impact of myocardial structure and functionpostinfarction on diastolic strain measurements: implications for assessment of myocardial viability. Am J Physiol Heart Circ Physiol, 2006, 290:H724-H731.
12. Takeuchi M, Otsuji Y, Lang RM, et al. Evaluation of left ventricular function using left ventricular twist and torsion parameters. Curr Cardiol Rep, 2009, 11:225-230
13. Gibbons Kroeker CA, Tyberg JV, Beyar R, et al. Effects of load manipulations, heart rate, and contractility on left ventricular apical rotation: an experimental study in anesthetized dogs. Circulation, 1995, 92:130-141.
14. Park SJ, Miyazaki C, Bruce CJ, et al. Left ventricular torsion by two-dimensional speckle tracking echocardiography in patients with diastolic dysfunction and normal ejection fraction. J Am Soc Echocardiogr, 2008, 21:1129-1137.
15. Wang J, Kurrelmeyer KM, Torre-Amione G, et al. Systolic and diastolic dyssynchrony in patients with diastolic heart failure and the effect of medical therapy. J Am Coll Cardiol, 2007, 49:88–96.
16. Rivas-Gotz C, Manolios M, Thohan V, et al. Impact of left ventricular ejection fraction on estimation of left ventricular filling pressures using tissue Doppler and flow propagation velocity. Am J Cardiol, 2003, 91:780-784.
17. Kasner M, Westermann D, Steendijk P, et al. Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction: a comparative Doppler-conductance catheterization study. Circulation, 2007, 11:637-647.
18. Pislaru C, Bruce CJ, Anagnostopoulos PC, et al. Ultrasound strain imaging of altered myocardial stiffness: stunned versus infarcted reperfused myocardium. Circulation, 2004, 109: 2905-2910.
19. Pavlopoulos H, Nihoyannopoulos P. Abnormal segmental relaxation patterns in hypertensive disease and symptomatic diastolic dysfunction detected by strain echocardiography. J Am Soc Echocardiogr, 2008, 21:899-906.
20. Wang J, Khoury DS, Thohan V, et al. Global diastolic strain rate for the assessment of left ventricular relaxation and filling pressures. Circulation, 2007, 115:1376-1383.
21. Granzier H, Wu Y, Siegfried L, et al. Titin: physiological function and role in cardiomyopathy and failure. Heart Fail Rev, 2005, 10:211-223.
22. Dalen BM, Soliman OI, Vletter WB, et al. Left ventricular untwisting in restrictive and pseudorestrictive left ventricular filling: novel insights into diastology. Echocardiogr, 2009, 18. [Epub ahead of print].
23. Burns AT, La Gerche A, Prior DL, et al. Left ventricular untwisting is an important determinant of early diastolic function. JACC Cardiovasc Imaging, 2009, 2:709-16.
24. Dong SJ, Hees PS, Siu CO. MRI assessment of LV relaxation by untwisting rate: a new isovolumic phase measure of tau. Am J Physiol Heart Circ Physiol, 2001, 281: H2002-H2009.
25. Wang J, Khoury DS, Yue Y, et al. Left ventricular untwisting rate by speckle tracking echocardiography. Circulation.2007, 116:2580-2586.
26. Takeuchi M, Borden WB, Nakai H, et al. Reduced and delayed untwisting of the left ventricle in patients with hypertension and left ventricular hypertrophy: a study using two-dimensional speckle tracking imaging. Eur Heart J, 2007, 28:2756-2762.
27. Villari B, Vassalli G, Betocchi S, et al. Normalization of left ventricular nonuniformity late after valve replacement for aortic stenosis. Am J Cardiol, 1996, 78:66-71.
28. Park TH, Lakkis NM, Middleton KJ, et al. Acute effect of nonsurgical septal reduction therapy on regional left ventricular asynchrony in patients with hypertrophic obstructive cardiomyopathy. Circulation, 2002, 106:412-415.
29. Kitzman DW, Higginbotham MB, Cobb FR, et al. Exercise intolerance in patients with heart failure and preserved leftventricular systolic function: failure of the Frank-Starling mechanism.J Am Coll Cardiol, 1991, 17:1065-1072.
30. Westermann D, Kasner M, Steendijk P, et al. Role of left ventricular stiffness in heart failure with normal ejection fraction. Circulation, 2008, 117:2051-2060.
31. Burgess MI, Jenkins C, Sharman JE, et al. Diastolic stress echocardiography: hemodynamic validation and clinical significance of estimation of ventricular filling pressure with exercise. J Am Coll Cardiol, 2006, 47:1891-1900.
32. Talreja DR, Nishimura RA, Oh JK, et al. Estimation of left ventricular filling pressure with exercise by Doppler echocardiography in patients with normal systolic function: a simultaneous echocardiographic-cardiac catheterization study. J Am Soc Echocardiogr, 2007, 20:477-479.
2. Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med, 2006, 355: 251–259.
3. Abhayaratna WP, Marwick TH, Smith WT, et al. Characteristics of left ventricular diastolic dysfunction in the community: an echocardiographic survey. Heart, 2006, 92:1259–1264.
4.中华医学会心血管病分会,中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南.中华心血管病杂志. 2007, 35:1089-1090.
5. Zile MR, Baicu CF, Gaasch WH. Diastolic heart failure-abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med, 2004, 350: 1953–1959.
6. Edvardsen T, Gerber BL, Garot J, et al. Quantitative assessment of intrinsic regional myocardial deformation by doppler strain rate echocardiography in humans: validation against three-dimensional tagged magnetic resonance imaging. Circulation, 2002, 106: 50-56.
7. Fang ZY, Leano R, Marwick TH. Relationship between longitudinal and radial contractility in subclinical diabetic heart disease. Clin Sci (Lond), 2004, 106: 53-60.
8. Hansen A, Johansson BL, Wahren J, et al. C-peptide exerts beneficial effects on myocardialblood ?ow and function in patients with type 1 diabetes. Diabetes, 2002, 51:3077-3082.
9. Schneider C, Jaquet K, Malisius R, et al. Attenuation of cardiac remodelling by endocardial injection of erythropoietin: ultrasonic strain-rate imaging in a model of hibernating myocardium. Eur Heart J, 2007, 28: 499-509.
10. Wong CY, O’Moore-Sullivan T, Leano R, et al. Alterations of left ventricular myocardial characteristics associated with obesity. Circulation, 2004, 10:3081-3087.
11. Becker M, Hoffmann R, Kühl HP, et al. Analysis of myocardial deformation based on ultrasonic pixel tracking to determine transmurality in chronic myocardial infarction.Eur Heart J, 2006, 27:2560-2566.
1. Zile MP, Brutaert DL. New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation, 2002, 105: 1387-1393.
2. Shammas RL, Khan NUA, Nekkanti R. Diastolic heart failure and left ventricular diastolic dysfunction: What we know, and what we don't know! International Journal of Cardiology, 2007, 115 :284-292.
3.中华医学会心血管病分会,中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南.中华心血管病杂志. 2007, 35:1089-1090.
4. Dhar S, Koul D, Gilbert E, et al. Current concepts in diastolic heart failure. J Am Osteopath Assoc, 2008, 108: 203-209.
5. Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med, 2006, 355: 251-259.
6. Wang JW, Dirar SK, Yue Y, et al. Preserved left ventricular twist and circumferential deformation, but depressed longitudinal and radial deformation in patients with diastolic heart failure. Euro H J, 2008, 29:1283-1289.
7. Buchalter MB, Rademakers FE, Weiss JL, et al. Rotational deformation of the canine left ventricle measured by magnetic resonance tagging: effects of catecholamines, ischaemia, and pacing. Circulation, 1994, 28:629-635.
8. Torrent-Guasp F, Buckberg GD, Clemente C, et al. The structure and function of the helical heart and its buttress wrapping.I.The normal macroscopic structure of the heart. Semin Thorac Cardiovasc Surg, 2001, 13: 301-319.
9. Goffinet C, Chenot F, Robert A, et al. Assessment of subendocardial vs. subepicardial left ventricular rotation and twist using two-dimensional speckle tracking echocardiography: comparison with tagged cardiac magnetic resonance, European Heart Journal , 2009, 30: 608-617.
10. Rademakers FE, Buchalter MB, Rogers WJ, et al. Dissociation between left ventricular untwisting and filling. Accentuation by catecholamines. Circulation, 1992, 85:1572-1581.
11. Akagawa E, Murata K, Tanaka N, et a1. Left ventricular apical rotation is impaired inpatients with dilated cardiomyopathy:quantitative analysis by two-dimensional tissue tracking system. J Am Coll Cardiol, 2006, 47:97A.
12. Martinez DA, Guhl DJ, StanleyWC, Vailas AC. Extracellular matrix maturation in the left ventricle of normal and diabetic swine. Diabetes Res Clin Pract 2003, 59:1-9.
13.李朝军,刘望彭,谢明星等,超声二维斑点追踪显像Logistic回归联合评价慢性心功能不全患者心肌扭转的改变.中国超声医学杂志, 2008, 24, 506-510.
1. Zile MP, Brutaert DL. New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation, 2002, 105: 1387-1393.
2. Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med, 2006, 355: 251–259.
3. Abhayaratna WP, Marwick TH, Smith WT, et al. Characteristics of left ventricular diastolic dysfunction in the community: an echocardiographic survey. Heart, 2006, 92:1259–1264.
4.中华医学会心血管病分会,中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南.中华心血管病杂志, 2007, 35:1089-1090.
5. Shammas RL, Khan NUA, Nekkanti R, et al. Diastolic heart failure and left ventricular diastolic dysfunction: What we know, and what we don't know! International Journal of Cardiology, 2007, 115:284-292.
6. Paulus WJ, Tschope C, Sanderson JE, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J, 2007, 28:2539-2550.
7. Maurer MS, Burkhoff D, Fried LP. DW, et al. Ventricular structure and function in hypertensive participants with heart failure and a normal ejection fraction: the Cardiovascular Health Study. J Am Coll Cardiol, 2007, 49:972-981.
8. Wang JW, Dirar SK, Yue Y, et al. Preserved left ventricular twist and circumferential deformation, but depressed longitudinal and radial deformation in patients with diastolic heart failure. Euro H J, 2008, 29:1283-1289.
9. Martinez DA, Guhl DJ, Stanley WC, et al. Extracellular matrix maturation in the left ventricle of normal and diabetic swine. Diabetes Res Clin Pract, 2003, 59:1-9.
10. Shan K, Bick RJ, Poindexter BJ, et al. Relation of tissue Doppler derived myocardial velocities to myocardial structure and beta-adrenergic receptor density in humans. J Am Coll Cardiol, 2000, 36:891-896.
11. Park TH, Nagueh SF, Khoury DS, et al. Impact of myocardial structure and functionpostinfarction on diastolic strain measurements: implications for assessment of myocardial viability. Am J Physiol Heart Circ Physiol, 2006, 290:H724-H731.
12. Takeuchi M, Otsuji Y, Lang RM, et al. Evaluation of left ventricular function using left ventricular twist and torsion parameters. Curr Cardiol Rep, 2009, 11:225-230
13. Gibbons Kroeker CA, Tyberg JV, Beyar R, et al. Effects of load manipulations, heart rate, and contractility on left ventricular apical rotation: an experimental study in anesthetized dogs. Circulation, 1995, 92:130-141.
14. Park SJ, Miyazaki C, Bruce CJ, et al. Left ventricular torsion by two-dimensional speckle tracking echocardiography in patients with diastolic dysfunction and normal ejection fraction. J Am Soc Echocardiogr, 2008, 21:1129-1137.
15. Wang J, Kurrelmeyer KM, Torre-Amione G, et al. Systolic and diastolic dyssynchrony in patients with diastolic heart failure and the effect of medical therapy. J Am Coll Cardiol, 2007, 49:88–96.
16. Rivas-Gotz C, Manolios M, Thohan V, et al. Impact of left ventricular ejection fraction on estimation of left ventricular filling pressures using tissue Doppler and flow propagation velocity. Am J Cardiol, 2003, 91:780-784.
17. Kasner M, Westermann D, Steendijk P, et al. Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction: a comparative Doppler-conductance catheterization study. Circulation, 2007, 11:637-647.
18. Pislaru C, Bruce CJ, Anagnostopoulos PC, et al. Ultrasound strain imaging of altered myocardial stiffness: stunned versus infarcted reperfused myocardium. Circulation, 2004, 109: 2905-2910.
19. Pavlopoulos H, Nihoyannopoulos P. Abnormal segmental relaxation patterns in hypertensive disease and symptomatic diastolic dysfunction detected by strain echocardiography. J Am Soc Echocardiogr, 2008, 21:899-906.
20. Wang J, Khoury DS, Thohan V, et al. Global diastolic strain rate for the assessment of left ventricular relaxation and filling pressures. Circulation, 2007, 115:1376-1383.
21. Granzier H, Wu Y, Siegfried L, et al. Titin: physiological function and role in cardiomyopathy and failure. Heart Fail Rev, 2005, 10:211-223.
22. Dalen BM, Soliman OI, Vletter WB, et al. Left ventricular untwisting in restrictive and pseudorestrictive left ventricular filling: novel insights into diastology. Echocardiogr, 2009, 18. [Epub ahead of print].
23. Burns AT, La Gerche A, Prior DL, et al. Left ventricular untwisting is an important determinant of early diastolic function. JACC Cardiovasc Imaging, 2009, 2:709-16.
24. Dong SJ, Hees PS, Siu CO. MRI assessment of LV relaxation by untwisting rate: a new isovolumic phase measure of tau. Am J Physiol Heart Circ Physiol, 2001, 281: H2002-H2009.
25. Wang J, Khoury DS, Yue Y, et al. Left ventricular untwisting rate by speckle tracking echocardiography. Circulation.2007, 116:2580-2586.
26. Takeuchi M, Borden WB, Nakai H, et al. Reduced and delayed untwisting of the left ventricle in patients with hypertension and left ventricular hypertrophy: a study using two-dimensional speckle tracking imaging. Eur Heart J, 2007, 28:2756-2762.
27. Villari B, Vassalli G, Betocchi S, et al. Normalization of left ventricular nonuniformity late after valve replacement for aortic stenosis. Am J Cardiol, 1996, 78:66-71.
28. Park TH, Lakkis NM, Middleton KJ, et al. Acute effect of nonsurgical septal reduction therapy on regional left ventricular asynchrony in patients with hypertrophic obstructive cardiomyopathy. Circulation, 2002, 106:412-415.
29. Kitzman DW, Higginbotham MB, Cobb FR, et al. Exercise intolerance in patients with heart failure and preserved leftventricular systolic function: failure of the Frank-Starling mechanism.J Am Coll Cardiol, 1991, 17:1065-1072.
30. Westermann D, Kasner M, Steendijk P, et al. Role of left ventricular stiffness in heart failure with normal ejection fraction. Circulation, 2008, 117:2051-2060.
31. Burgess MI, Jenkins C, Sharman JE, et al. Diastolic stress echocardiography: hemodynamic validation and clinical significance of estimation of ventricular filling pressure with exercise. J Am Coll Cardiol, 2006, 47:1891-1900.
32. Talreja DR, Nishimura RA, Oh JK, et al. Estimation of left ventricular filling pressure with exercise by Doppler echocardiography in patients with normal systolic function: a simultaneous echocardiographic-cardiac catheterization study. J Am Soc Echocardiogr, 2007, 20:477-479.